16 y/o mvc

[Tigger]

Kinda like here: http://vimeo.com/49527742

They got a patient in with a cut in his femoral artery. Homeboy amberlamps to the ER, by the time he's rolled in, he's DOA asystole, not even any blood left in him. Surgeons start compression, crack his chest, do their cardiac workup with bloods and everything and get stable pulses back. Pt is discharged to a facility for rehab. Not sure HOW mentally disabled he is, but the way it makes it sounds, he's alert.

Kind of apples to oranges though, don't you think? The above patient does not have multi-system destruction as a result of blunt trauma, making him a bit easier to manage I'd imagine.

 

[exodus]

Kind of apples to oranges though, don't you think? The above patient does not have multi-system destruction as a result of blunt trauma, making him a bit easier to manage I'd imagine.

Oh, I wasn't posing an argument, I just thought it was a cool thing to watch and kinda worked for what you were saying

 

[Akulahawk]

Kinda like here: http://vimeo.com/49527742

They got a patient in with a cut in his femoral artery. Homeboy amberlamps to the ER, by the time he's rolled in, he's DOA asystole, not even any blood left in him. Surgeons start compression, crack his chest, do their cardiac workup with bloods and everything and get stable pulses back. Pt is discharged to a facility for rehab. Not sure HOW mentally disabled he is, but the way it makes it sounds, he's alert.

This is one of those very rare occasions when you have a trauma team ready to go, a patient that's got some blood still in the body, and they're able to save him (for the minute) because he probably lost his vital signs right about the time he was dragged into the ED. I would imagine that had his aorta been transected, they'd be telling a totally different story.

Furthermore, nobody in the scenario at hand in this thread is very likely to crack the patient's chest, attempt to clamp the aorta and go to town because there's still some very significant wounds that would continue to bleed even with the aorta clamped.

There's such a thing as non-survivable injury. The patient in this scenario is one such case.

 

[Akulahawk]

Oh, I wasn't posing an argument, I just thought it was a cool thing to watch and kinda worked for what you were saying

Very interesting case... but that case just isn't the same as the scenario case, for a whole host of reasons.

 

[Carlos Danger]

Kind of apples to oranges though, don't you think? The above patient does not have multi-system destruction as a result of blunt trauma, making him a bit easier to manage I'd imagine.

Penetrating vs. blunt trauma is apples and oranges.

In the video you have a patient with a focal injury and probably a short pulseless time. Stop the bleeding by clamping the aorta, pump him full of blood, start his heart, and as long as he wasn't pulseless for too long, he is stabilized and may recover.

In the scenario the OP posted, however, you have a patient with a history and clinical signs suggestive of both massive diffuse CNS injury, which cannot be repaired, AND thoracic trauma, AND likely and a much longer down time.

Very different injury patterns and circumstances.

 

[ffemt8978]

Not to mention the unknown time from injury onset to EMS arrival, plus the 6-7 minutes minimum to get to the local doc in the box or 12-15 minutes to get to the trauma center.

So what we're dealing with is a patient who has no pulses for an absolute minimum of 15 minutes (assuming, of course, that EMS only spends 10 minutes on scene) before they arrive at a hospital, and more likely 30-45 minutes.

 

[paccookie]

This is one of those very rare occasions when you have a trauma team ready to go, a patient that's got some blood still in the body, and they're able to save him (for the minute) because he probably lost his vital signs right about the time he was dragged into the ED. I would imagine that had his aorta been transected, they'd be telling a totally different story.

Furthermore, nobody in the scenario at hand in this thread is very likely to crack the patient's chest, attempt to clamp the aorta and go to town because there's still some very significant wounds that would continue to bleed even with the aorta clamped.

There's such a thing as non-survivable injury. The patient in this scenario is one such case.

Agreed. However the trauma center has the ability to harvest organs and the local hospital does too but very rarely ever does harvest organs. A trauma team would've been in place upon arrival and the parents would've had that option if anything was viable. Turns out this pt had an atlanto-occipital dislocation. We took her to the local hospital. Worked her primarily because her mother was on scene. And honestly if it had been my child, I would want everything possible done. The local hospital stabilized her airway using a fiber optic scope and managed to get a pulse and a blood pressure and then transferred her to the trauma center. As its 15 minutes away, that's a ground transport. She went on an epi drip and made it there, only to arrest again 15 minutes later.

 

[firecoins]

Take them to a hospital.

 

[Akulahawk]

Agreed. However the trauma center has the ability to harvest organs and the local hospital does too but very rarely ever does harvest organs. A trauma team would've been in place upon arrival and the parents would've had that option if anything was viable. Turns out this pt had an atlanto-occipital dislocation. We took her to the local hospital. Worked her primarily because her mother was on scene. And honestly if it had been my child, I would want everything possible done. The local hospital stabilized her airway using a fiber optic scope and managed to get a pulse and a blood pressure and then transferred her to the trauma center. As its 15 minutes away, that's a ground transport. She went on an epi drip and made it there, only to arrest again 15 minutes later.

I wonder how long that interval was between initiating transport and ROSC at the closest facility... followed by about 30 minutes of ROSC and demise.

I also wonder what organs may have been considered for donation given the amount of time where there was no blood flow...

 

[Jim37F]

Turns out this pt had an atlanto-occipital dislocation.

Isn't that where the skull separates from the spinal column?

 

[VFlutter]

I also wonder what organs may have been considered for donation given the amount of time where there was no blood flow...

And then followed by an Epi drip :blink: Maybe the corneas were still viable?

 

[Nattens]

Isn't that where the skull separates from the spinal column?

Correct, also called an Internal Decapitation. Very poor prognosis that only few have survived.

 

[Akulahawk]

Isn't that where the skull separates from the spinal column?

In a manner of speaking, yes. The skull dislocates off the 1st vertebrae (aka the Atlas). It also may or may not result in separation of the spinal cord from the brain, which is also a very bad thing. :blink:

 

[Akulahawk]

And then followed by an Epi drip :blink: Maybe the corneas were still viable?

I was thinking the same thing, actually.

 

[chaz90]

It also may or may not result in separation of the spinal cord from the brain, which is also a very bad thing. :blink:

Eh, definitely sounds like something that could just be plugged back in at the trauma center. That's how it works right?

 

[DesertMedic66]

Eh, definitely sounds like something that could just be plugged back in at the trauma center. That's how it works right?

Like an extension cord right?

 

[VFlutter]

Like an extension cord right?

Obviously a Nursing procedure.

 

[DesertMedic66]

Obviously a Nursing procedure.

Pretty sure it's an LVN skill in my neck of the woods :rofl:

 

[Akulahawk]

Just wait... eventually they'll just delegate it to a CNA. You know, part of "keeping the lights on."

 

[ffemt8978]

Just wait... eventually they'll just delegate it to a CNA. You know, part of "keeping the lights on."

And once the CNA's get that skill, it's only a matter of time before it becomes a Basic procedure that the NREMT tests on.